cirrhosis Images (Click to view larger image)
Cirrhosis is a chronic liver disease which causes degeneration of liver cells and decreased function of the liver.
What is going on in the body?
The liver filters out poisons, germs, bacteria, and wastes from the blood. It also releases vitamins, minerals, sugar, and immune agents back into the blood.
This means the liver can replace its own diseased or damaged cells with new cells. Liver transplants are possible because of this.
In some cases, however, the restoring process can cause problems. As the liver tries to repair itself, the new cell growth is surrounded by scar tissue. These nodules prevent the liver from restoring itself. The scar tissue blocks the flow of blood flow through the veins and arteries. Once cirrhosis sets in, it cannot be reversed. Treatment may be able to stop or delay further damage.
What are the signs and symptoms of the condition?
Most people with cirrhosis have few symptoms in the early stages. But as more clumps of cells surrounded by scar tissue grow, the liver function slows down. Symptoms start becoming more noticeable at this point. As liver function starts to fail, people may experience: As cirrhosis progresses through the liver, symptoms become worse. The following problems can occur as a result:
What are the causes and risks of the condition?
- spider naevi, which are small, red, and spidery marks. They may appear on the skin anywhere above the waist.
- jaundice, or a yellowing of the skin and eyes. It occurs when the liver cannot remove bilirubin from the blood and process it as waste from the body. Bilirubin is a reddish yellow pigment that is in blood.
- bruising and/or bleeding. This occurs because lack of protein in the blood. The diseased liver cannot make the proteins needed to help the blood clot.
- cognitive impairment, or decrease in mental function. As toxins buildup in the brain, cognitive impairment progresses from mild loss of concentration to increasing confusion. In addition, the person may experience personality changes, irritability, drowsiness, lack of interest in people and events, and eventually coma and death.
- sensitivity to medications. This occurs because the liver cannot filter out medications from the blood at its usual rate. As a result, medications build up in the body.
- portal hypertension, or increased blood pressure in the liver
- varicose veins. These develop on the stomach and oesophagus. They are caused by enlarged blood vessels. These vessels become thin because the extra blood stretches the wall of the vessel. Bleeding from these varicose veins is one of the most serious complications of cirrhosis.
- haemorrhoids. These occur as a reaction to portal hypertension. Factors causing haemorrhoids are similar to those that cause varicose veins.
- swelling in the legs and swelling in the abdomen, or ascites. Swelling is caused when the liver loses its ability produce proteins and filter out sodium. Portal hypertension can also cause these conditions.
- bacterial infection. Infection occurs because the thin membrane that lines the stomach and encloses many organs gets infected. This may be caused by portal hypertension. The creating of new pathways for blood from the small intestines may allow bacteria to enter the blood.
There are several causes of cirrhosis. They include:
What can be done to prevent the condition?
- chronic alcoholism. This is a relatively common cause of cirrhosis in the Australia. It is determined based on the amount of alcohol a person drinks. In women, about 3 to 4 drinks (one drink =12 oz of beer, 5 oz of wine, or 1.5 oz of 80-proof liquor) a day for 10 to 15 years can cause cirrhosis. It men, it takes about 5 to 6 drinks a day for 10 to 15 years for the disease to occur.
- infectious causes. This is one of the most common causes of liver disease. Examples of common infections are hepatitis A, hepatitis B, hepatitis C, and hepatitis D.
- congenital causes, or inherited disease, including:
- haemorrhagic telangiectasia, a condition in which thin blood vessels allow frequent and easy bleeding of the skin and digestive tract
- galactosaemia, or the inability to metabolise a simple sugar known as galactose
- tyrosinosis, a disorder caused by faulty metabolism of a common amino acid
- hereditary fructose intolerance, or the inability to digest a sugar commonly found in fruit
- alpha-1 antitrypsin deficiency, an enzyme deficiency which also causes emphysema
- thalassemia, a group of hereditary anaemias
- Wilson's disease, a disorder which allows copper to accumulate in the liver and other organs
- Haemochromatosis, a disorder which causes excess accumulation of iron in the body
- chemical causes, which are rare. Cirrhosis can be caused by a severe reaction to a medication. It can also be caused by prolonged contact with methotrexate, arsenic, carbon tetrachloride, or excessive amounts of vitamin A.
- biliary obstructive causes. This refers to blocked bile ducts causing liver damage. Babies born with biliary atresia either do not have bile ducts or have injured ones. In adults, obstruction can occur for no known reason. Or, it can occur if the surgeon accidentally did not tie off the injured bile ducts during gallbladder surgery.
- other causes, including:
- years of severe right-sided heart failure
- the parasitic infection schistosomiasis
- some childhood disorders such as cystic fibrosis
The most important way to prevent cirrhosis is to avoid excessive alcoholic drinking. Progression of cirrhosis caused by drinking can be avoided if the person stops drinking.
Maintaining good personal hygiene can prevent hepatitis. This includes washing hands after going to the bathroom. It also includes avoiding food or water that has been contaminated by sewage. Since some types of hepatitis are sexually transmitted, monogamous heterosexual or homosexual activities with an uninfected partner can prevent hepatitis. Vaccines against hepatitis A and B are available.
How is the condition diagnosed?
A doctor can decide that a person's symptoms, medical history, and physical examination are consistent with cirrhosis. Other tests may also be used to support the diagnosis. These include: The only way to definitively diagnosis the presence of cirrhosis is by a liver biopsy. This involves the removal of a small piece of liver tissue that is examined under a microscope.
What are the long-term effects of the condition?
Cirrhosis is usually progressive. There is no cure for it. The severe long-term effects of cirrhosis are a result of the portal hypertension. These include: If cirrhosis is diagnosed early in a person abusing alcohol, the chance for recovery is excellent if that person stops drinking alcohol permanently and follows medical advice. Problems are significant if cirrhosis progresses before it is discovered and treated.
A person who suffers cirrhosis due to complications from hepatitis or primary biliary cirrhosis may regain a normal life after a successful liver transplant. People who are suffering from chronic alcoholism may not be good candidates for a liver transplant because of the damage done to the rest of their body.
What are the risks to others?
If the cirrhosis is caused by hepatitis, the person may pose a risk to others, since hepatitis is contagious. Chronic alcoholism is the primary cause of cirrhosis. Drinking reduces judgment, impulse control, and motor control. This puts the individual and others at risk for accidents or emotional problems.
What are the treatments for the condition?
Specific treatments for cirrhosis depend upon what caused the liver disease and any known complications. The first step in treating alcoholic cirrhosis is to provide the encouragement and support systems needed for the person to avoid drinking. Next, the individual can be offered suggestions for improved diet and a specific treatment plan for any complications.
Hepatitis can be treated using medications. These include as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis.
To treat Wilson's disease, the doctor may prescribe trientine or penicillamine. If these medications cannot be tolerated, then the person may be asked to take zinc acetate.
haemochromatosis is treated by removing a pint of blood once a week for 1 to 2 years. This will effectively deplete the excess iron.
Fat-soluble vitamin supplements are given to prevent complications from primary biliary cirrhosis. These include a water-soluble form of vitamin A, vitamin D in the form of either 25-dihydroxyvitamin D3 or 1,25-dihydroxyvitamin D3, vitamin E, an oral form of vitamin K, and supplemental calcium. Cholestyramine may be given to help relieve itching.
Finally, liver transplantation has become a widely accepted form of treatment. The 1- and 5-year survival rates after transplantation are at 90% and 80% respectively. There are very specific indications for liver transplantation. The major problem with liver transplants are the limited supply of donor organs.
What are the side effects of the treatments?
Side effects depend on the treatments used. All medications have possible side effects. For example, antibiotics may cause allergic reactions or stomach upset. Surgery carries a risk of bleeding and infection.
The medications that must be taken to prevent rejection after a liver transplant have many side effects. These include allergic reactions, stomach upset and kidney damage. Because these medications suppress the immune system, there is also an increased risk of infection.
What happens after treatment for the condition?
Cirrhosis is usually progressive. A person who has cirrhosis due to alcohol may stop the progression of the cirrhosis when drinking stops. However, the scar tissue will remain.
How is the condition monitored?
A person with cirrhosis should have frequent physical examinations by the doctor. This helps the doctor to monitor the activity of the disorder and determine possible complications. Frequent blood tests, including a FBC and liver function tests, may help monitor the disorder as well.
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request